e-Library of Evidence for Nutrition Actions (eLENA)


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Balanced energy and protein supplementation during pregnancy

Intervention | Last updated: 20 June 2023


The nutritional status of women prior to and during pregnancy plays a key role in fetal growth and development. Undernourished pregnant women may be at increased risk for adverse pregnancy outcomes, including giving birth to low-birth-weight infants.

Providing balanced protein energy supplementation (i.e. supplements in which protein provides less than 25% of the total energy content) to undernourished pregnant women has been shown to promote gestational weight gain and improve pregnancy outcomes.

Current evidence indicates that balanced energy and protein supplementation improves fetal growth, and may reduce the risk of stillbirth, low-birth-weight infants and infants born small-for-gestational age, especially among undernourished pregnant women. High-protein supplementation during pregnancy does not appear to be beneficial and may be harmful to the fetus. The evidence further suggests that antenatal nutritional advice with the aim of increasing maternal energy and protein intake may be effective in increasing maternal protein intake and reducing the risk of preterm birth.

WHO Recommendations


In undernourished populations, balanced energy and protein dietary supplementation is recommended for pregnant women to reduce the risk of stillbirths and small for gestational age neonates.

Evidence


Systematic reviews used to develop the guidelines


Antenatal dietary education and supplementation to increase energy and protein intake

Ota E, Hori H, Mori R, Tobe-Gai R, Farrar D. Cochrane Database of Systematic Reviews. 2015; Issue 6. Art. No.: CD000032.

Summary of this review Alternate Text

Other related systematic reviews


Effects of protein energy supplementation during pregnancy on fetal growth: a review of the literature focusing on contextual factors

Liberato SC, Singh G, Mulholland K. Food & Nutrition Research. 2013; 57.


Effect of balanced protein energy supplementation during pregnancy on birth outcomes

Imdad A, Bhutta ZA. BMC Public Health. 2011; 11(Suppl.3):S17.


Maternal nutrition and birth outcomes: effect of balanced protein-energy supplementation

Imdad A, Bhutta ZA. Paediatric and Perinatal Epidemiology. 2012; 26 (Suppl.1):178-90.


The effect of balanced protein energy supplementation in undernourished pregnant women and child physical growth in low- and middle-income countries: a systematic review and meta-analysis

Stevens B, Buettner P, Watt K, Clough A, Brimblecombe J, Judd J. Maternal & Child Nutrition. 2015; 11(4):415-32.


Cost-effectiveness Learn More Alternate Text


Relevant cost-effectiveness analyses have not yet been identified.